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Clinical Medicine 2 > Exam 1 - CAD, angina > Flashcards

Exam 1 - CAD, angina Flashcards

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1
Q

What happens in the coronary arteries in CAD?

A

Increased number of abnormal smooth muscle cells with deposits of cholesterol and other substances.

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2
Q

What can happen with increased vascular resistance due to a clot?

A

Rupture the clot which leads to an MI

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3
Q

What is the Framingham Risk Score?

A

10 year risk of CAD. Doesn’t include FHx or DM.

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4
Q

Some common CAD risk factors?

A

Over 65 y/o, DM (CAD equivalent), 1st degree relative with premature MI (women under 65, men under 55), Metabolic Syndrome, cocaine use

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5
Q

Metabolic Syndrome criteria?

A 
3 or more
Abdominal/central obesity
TG above 150
Men HDL under 40, women HDL under 50
HTN
Fasting glucose above 110
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6
Q

What is Primary Prevention of CAD?

A

Don’t have CAD, want to prevent CAD.

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7
Q

How to achieve CAD primary prevention?

A

Normal, Ideal weight, physical activity, Mediterranean diet, don’t smoke, BP under 140/90 or 130/80 if positive risk factors, glycemic control, daily ASA with high risk, small EtOH consumption

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8
Q

3 categories of CP?

A
  1. Classical/Typical Angina=SOB, substernal pain, typical crushing quality, 5-15min in duration, better with rest or ntg
  2. Probable/Atypical Angina=CP with 2/3 of typical
  3. Nonanginal/Nonischemic=1 or none of typical
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9
Q

How long does Classical/Typical Angina last for? What makes it better?

A

5-15min duration. Better with rest or NTG

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10
Q

General Physical Exam with CAD?

A

Often normal. Abdominal obesity, sweaty, SOB with minimal exertion.

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11
Q

Apple Body vs Pear Body risk?

A

Apple Body=increased risk. Carries weight in abdomen.

Pear Body=decreased risk. Fat in butt and thighs.

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12
Q

Peripheral pulses in CAD?

A

Decreased from PAD

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13
Q

Bruits in CAD located here?

A

Carotid, renal, aorta, or femoral arteries

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14
Q

EKG in early or stable CAD?

A

Normal in early or stable CAD.

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15
Q

Pathlogic Q-wave demonstrates what?

A

Prior MI

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16
Q

Non-specific ST-T abnormalities demonstrate what?

A

Previous or active ischemia

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17
Q

Describe is Angina Pectoria?

A

Chest pain attributed to myocardial ischemia. Oxygen supply/demand mismatch.

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18
Q

Describe Angina Equivalent

A

Sx other than chest pain attributed to myocardial ischemia: SOB, dizzy, nausea, fatigue

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19
Q

What are the 4 main oxygen demand factors?

A
  1. HR
  2. SBP
  3. Myocardial wall tension/stress
  4. Myocardial contractility
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20
Q

Describe Chronic Stable Angina?

A

CP w/exertion for 5-15 min. Centrally located. Predictable and reproducable. Relieved w/rest and/or NTG. Fatigue, presyncope.

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21
Q

Describe Unstable Angina

A

Sx at rest or less exertion than baseline. Plaque increasing.

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22
Q

What is the main method of diagnosing CAD?

A

Stress testing

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23
Q

Angina and stress testing appropriate and CI?

A

Appropriate in stable angina. Contraindicated in unstable angina.

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24
Q

Indication for Stress Testing?

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A

PT with Sx suggesting stable angina w/intermediate pretest probability of dz.

25
What sort of scan for CAD do very obese patients get?
PET scan
26
What is the first-line stress test? Who gets it?
Exercise tolerance test. Must have normal EKG and low-to-moderate CAD risk
27
What does a Stress Echo do?
Looks for stress-indiced regional wall abnormalities to location lesion in coronary arteries. Done at rest and after stress.
28
What is Radionucleotide Myocardial Perfusion Imaging?
Nuclear med test to locate lesion in artery. No color update=poorly perfused tissue. Very sensitive, very expensive!
29
3 types of Acute Coronary Syndrome?
1. Unstable Angina 2. NSTEMI 3. STEMI
30
What is the classic ACS presentation?
Early morning substernal chest pressure radiation to left/both arms and/or jaw, sense of doom, SOB, N/V, diaphoresis, light-headed, 20m-1h
31
Describe Unstable Angina ACS? (Hint: ischemia, Troponins, plaque, EKG?)
ACS with ischemic symptoms. No increased cardiac biomarkers. Unstbale plaque, no rupture, artery not yet obstructed. EKG=norm or S-T depression or T-wave inversion
32
Describe NSTEMI ACS? (Hint: ischemia, Troponins, plaque, EKG?)
Increased cardiac biomarkers. Unstable plaque with or without rupture. Significant narrowing of artery. EKG=No S-T elevation. S-T depression. Non-Q-Wave-MI.
33
Describe STEMI ACS? (Hint: ischemia, Troponins, plaque, EKG?)
Positive cardiac biomarkers. Plaque ruptures and complete occlusion of artery. EKG=greater than 2mm ST elevation in two contiguous precordial leads OR greater than 1mm ST elevatio in two contiguous other leads. Q-Wave-MI. New LBBB is MI until ruled out. Reciorcal changes.
34
What is most important factor in diagnosing ACS?
Story is #1 most important factor
35
What to do with EKGs during ACS?
Compare new ro old
36
Which cardiac biomarkers show in blood first?
CK-MB first. TnI and TnT later.
37
EKG leads for LAD occlusion?
V2, V3, V4. Anterior.
38
EKG leads for lateral LCA occlusion?
I, aVL, V5, V6
39
EKG leads for RCA inferior occlusion?
II, III, aVF
40
EKG leads for RCA ventral occlusion?
aVR, VI
41
EKG leads for RCA Posterior occlusion?
ST depresison in V2-V4
42
When to revascularize UA/NSTEMI?
Hemodynamically unstable/cardiogenic shock Severe LV dysfunction or severe HF Recurrent or persistent angina despite max meds New or worse mitral regurg Sustained ventricular arrythmias
43
Tx of STEMI?
``` Morphine for CP (esp if NTG not working) O2 is SpO2 less than 90% Nitrates for CP, 0.4mg SL q5m x3 then morphine ASA 324/325mg Anticoagulate, K and Mg mgt ```
44
What 3 tx improve outcomes of STEMI?
1. Beta-blocker=Metoprolol. Prevent tissue ischemia and vent arrythmias 2. High dose statin=80mg Atoravastatin 3. Anti-platelet therapy
45
Why give anticoagulants during and after stenting?
Prevent stents from clotting
46
Time for reperfusion in STEMI?
90 minutes door to balloon!
47
Who gets Prinzmetal Angina (Variant Angina)?
Younger PTs. FHx w/genetic factors.
48
Risk factors for Prinzmetal Angina (Variant Angina)?
Drug use, insulin resistance, smoking
49
Patho of Prinzmetal Angina (Variant Angina)?
Vascular smooth muscle hyperreactive causing focal spasm of major coronary artery. High grade transient artery obstruction
50
Prinzmetal Angina (Variant Angina) and CV risk factors?
Few CV risk factors
51
What can happen if Prinzmetal Angina (Variant Angina) occurs for long enough?
MI
52
Triggers for Prinzmetal Angina (Variant Angina)?
Changes in autonomic variability, drugs (ephedrine, cocaine, pot), Mg2+ deficiency
53
When does Prinzmetal Angina (Variant Angina) occur?
Midnight to early morning
54
Prinzmetal Angina (Variant Angina) PE? EKG?
Angina at rest. Transient 15m ST segment elevation. Normal after episode.
55
Tx for Prinzmetal Angina (Variant Angina)?
NTG is key to treatment during episodes. Long-lasting nitrates and CCBs to prevent vasoconstriction and promote vasodilation or coronary arteries. Statins, Mg supplementation, and PCI w/stent (rare).
56
DM is what sort of risk in CAD?
"CAD equivalent"
57
MI in DM presents how?
Atypically. Nausea, feeling "off"
58
What tests if need to know lesion location?
Imaging. | Echo, SPECT, PET-CT

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